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Palliative care strategies in the management of people with serious cases of COVID-19
Revista Brasileira de Enfermagem. 2023;76:e20220308
Abstract
Palliative care strategies in the management of people with serious cases of COVID-19
Revista Brasileira de Enfermagem. 2023;76:e20220308
DOI 10.1590/0034-7167-2022-0308
Views0See moreABSTRACT
Objectives:
to analyze the assistance strategies in palliative care developed in the COVID-19 pandemic for critically ill patients and their families.
Methods:
an integrative review carried out in August 2021 and updated in April 2022 in the Base de Dados de Enfermagem (BDENF), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), US National Library of Medicine (PubMed), Web of Science databases, and presented in the PRISMA flowchart.
Results:
thirteen works were selected for reading and content analysis, from which emerged the two main themes that reflect the reality evidenced in this context: The sudden advent of COVID-19 with impacts on palliative care; and The strategies used in palliative care to mitigate these impacts.
Final Considerations:
palliative care is the best strategy for providing health care, used as a comfort to bring relief and comfort to patients and families.
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ORIGINAL ARTICLE03-06-2023
Construct elaboration and validity of the Pregnancy Depression Risk Scale
Revista Brasileira de Enfermagem. 2023;76(2):e20220306
Abstract
ORIGINAL ARTICLEConstruct elaboration and validity of the Pregnancy Depression Risk Scale
Revista Brasileira de Enfermagem. 2023;76(2):e20220306
DOI 10.1590/0034-7167-2022-0306
Views0See moreABSTRACT
Objectives:
to elaborate and analyze the Pregnancy Depression Risk Scale psychometric properties.
Methods:
methodological research, in six steps: theoretical model empirical definition; elaboration of scale items with literature review; consultation with five professional health experts and 15 pregnant women; content validity with six experts; pre-test-semantic validity with 24 pregnant women; scale factor structure definition with 350 pregnant women; pilot study with 100 pregnant women, totaling 489 pregnant women and 11 experts. Data were analyzed by content analysis, exploratory factor analysis, multitrait-multimethod analysis and internal consistency.
Results:
sixty-eight risk factors were identified for item formulation. The final version of the scale consisted of 24 items in five domains. The scale demonstrated satisfactory construct content, semantic, validity and reliability.
Conclusions:
the scale proved to be valid in terms of content and semantics, with a factor structure defined according to the adopted theoretical model and satisfactory psychometric properties.
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ORIGINAL ARTICLE03-06-2023
Medication reconciliation in pediatrics: a validation of instruments to prevent medication errors
Revista Brasileira de Enfermagem. 2023;76(2):e20210755
Abstract
ORIGINAL ARTICLEMedication reconciliation in pediatrics: a validation of instruments to prevent medication errors
Revista Brasileira de Enfermagem. 2023;76(2):e20210755
DOI 10.1590/0034-7167-2021-0755
Views0ABSTRACT
Objectives:
to develop and validate the content of two instruments for promoting medication reconciliation for the transition of care of hospitalized children.
Methods:
methodological study, conducted in five stages: scope review for conceptual structure; elaboration of the initial version; content validation with five specialists using the Delphi technique; reassessment; and construction of the final version of the instruments. A content validity index of at least 0.80 was adopted.
Results:
three rounds of evaluation were carried out to reach the validity index of the proposed contents, whereas a new analysis of 50% of the 20 items of the instrument aimed at families, and 28.5% of the 21 items aimed at professionals was necessary. The instrument aimed at families reached an index of 0.93, and the instrument for professionals, 0.90.
Conclusions:
the proposed instruments were validated. It is now possible to proceed with practical implementation studies to identify their influence on safety during medication reconciliation at transition of care.
Keywords:Medication errorsMedication ReconciliationPatient SafetyPediatricsProfessional-Family RelationsSee more -
ORIGINAL ARTICLE03-06-2023
Organizational politics and professional struggles in nursing
Revista Brasileira de Enfermagem. 2023;76(1):e20220180
Abstract
ORIGINAL ARTICLEOrganizational politics and professional struggles in nursing
Revista Brasileira de Enfermagem. 2023;76(1):e20220180
DOI 10.1590/0034-7167-2022-0180
Views0See moreABSTRACT
Objective:
to analyze the professional struggles between nursing organizational entities, in Rio de Janeiro, during the Regional Nursing Council’s electoral process (1990-1993 administration).
Method:
historical study. We used journalistic articles, normative documents, legislation and semi-structured interviews with five nursing professionals who participated in this process. Interpretation of findings was supported by Bourdieu’s concepts of habitus, field, capital, and symbolic power.
Results:
Electoral Code changes of the aforementioned council, under the influence of administration (1987-1990), candidate for re-election, influenced the disclosure and eligibility criteria, making it difficult for broad participation, especially of Associação Brasileira de Enfermagem Rio de Janeiro Section.
Final considerations:
nursing, in this period, generated a field of disputes related to positions of power and gender, which was evidenced in the electoral process studied, which highlighted using limiting strategies by a group, making it difficult for the entire category to participate.
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Proyecto Termómetro Social COVID-19: articulaciones transnacionales para abordar poblaciones en situación de vulnerabilidad social
Revista Brasileira de Enfermagem. 2023;76:e76suppl201
Abstract
Proyecto Termómetro Social COVID-19: articulaciones transnacionales para abordar poblaciones en situación de vulnerabilidad social
Revista Brasileira de Enfermagem. 2023;76:e76suppl201
DOI 10.1590/0034-7167.202376suppl201es
Views0El COVID-19 es una enfermedad infecciosa que ha impactado significativamente diferentes contextos alrededor del mundo, directa y/o indirectamente, y en mayor escala en países pobres y/o en vías de desarrollo(). No sabemos con certeza los efectos acumulativos del COVID-19 en las poblaciones (trastornos mentales, insomnio, ansiedad, trombosis, déficit cognitivo, problemas de memoria, etc.) tras la […]See more -
COVID-19 Social Thermometer Project: transnational articulations to approach populations in situations of social vulnerability
Revista Brasileira de Enfermagem. 2023;76:e76suppl201
Abstract
COVID-19 Social Thermometer Project: transnational articulations to approach populations in situations of social vulnerability
Revista Brasileira de Enfermagem. 2023;76:e76suppl201
DOI 10.1590/0034-7167.202376suppl201
Views0COVID-19 is an infectious disease that has significantly impacted different contexts around the world, directly and/or indirectly, and on a larger scale in poor and/or developing countries(). We do not know for sure the cumulative effects of COVID-19 on populations (mental disorders, insomnia, anxiety, thrombosis, cognition deficit, memory problems, etc.) after exposure to infection by […]See more
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Factors associated with immunization against Hepatitis B among workers of the Family Health Strategy Program
Revista Brasileira de Enfermagem. 2015;68(1):84-92
Abstract
Factors associated with immunization against Hepatitis B among workers of the Family Health Strategy Program
Revista Brasileira de Enfermagem. 2015;68(1):84-92
DOI 10.1590/0034-7167.2015680112p
Views0See moreObjective:
to investigate the report of vaccination against Hepatitis B, verification of immunization and the factors associated with dosages of anti-HBs.
Method:
we collected blood samples from those reported that they had one or more doses of the vaccine. We evaluated the association of the dosage of anti- HBs with sociodemographic conditions, occupational and behavioral. The associations were verified by Mann Whitney and Kruskal Wallis and correlation Spermann by linear regression using SPSS® 17.0.
Results:
among the 761 respondents, 504 (66.1%) were vaccinated, 52.5 % received three doses, 30.4 % verified immunization. Of the 397 evaluated for the determination of anti-Hbs, 16.4% were immune.
Conclusion:
it was found that longer duration of work was associated with higher levels of anti-HBs, while levels of smoking were inversely associated with anti-HBs. These workers need for vaccination campaigns.
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The decreasing number of cigarettes during psychiatric hospitalization: intervention or punishment?
Revista Brasileira de Enfermagem. 2015;68(1):76-83
Abstract
The decreasing number of cigarettes during psychiatric hospitalization: intervention or punishment?
Revista Brasileira de Enfermagem. 2015;68(1):76-83
DOI 10.1590/0034-7167.2015680111p
Views0See moreObjective:
To identify the mental disorders carriers’ perception, the smokers ones, about the decreasing number of cigarettes during psychiatric hospitalization.
Method:
Exploratory study with 96 hospitalized carriers of mental disorders who are smokers: G1 (34 subjects hospitalized when was allowed one cigarette by hour) and G2 (62 subjects hospitalized when it was reduced to eight cigarette by day). Semi-structured questionnaire. Thematic content analysis.
Results:
The G1 admitted satisfaction with the restriction – smoking during hospitalization as entitlement. The G2 resists the restriction change occurred without dialogue or support. In spite of the difficulties, some attitude changes about the cigarette were noticed such as increase of the responsibility, discovery of the ability to reduce smoking and the meaning of its role.
Conclusion:
Some subjects understand the smoking health policy change as punishment, while others as opportunity to think about the role of cigarette in their life.
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Family functionality in oldest old household residents
Revista Brasileira de Enfermagem. 2015;68(1):68-75
Abstract
Family functionality in oldest old household residents
Revista Brasileira de Enfermagem. 2015;68(1):68-75
DOI 10.1590/0034-7167.2015680110p
Views0See moreObjective:
the aim of this study was to identify factors associated with family functionality of non-institutionalized long-lived subjects, who were residents in Goiânia (GO), Brazil.
Method:
this was a population-based epidemiological study with cross-sectional outline. Evaluation scales of the functional and cognitive capacities were used. Family dynamics was measured using the Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) instrument by making home interviews with 131 long-lived individuals.
Results:
there was prevalence of the female gender, average of age of 83.87 years old, widowhood condition, and residence in a big family, primary schooling, and self-perception of regular health. A great amount showed independence for self-care and partial dependence for daily life instrumental activities. Family functionality prevailed with score average of 9.06 points.
Conclusion:
in conclusion, family functionality in long-lived subjects is associated with self-perception of poor/bad health, osteoporosis, and fall. Results allowed characterizing long-lived subjects’ family functionality with the aim of valuing and prioritizing family as a caregiver.
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Prevalence of non-adherence to antihypertensive pharmacotherapy and associated factors
Revista Brasileira de Enfermagem. 2015;68(1):60-67
Abstract
Prevalence of non-adherence to antihypertensive pharmacotherapy and associated factors
Revista Brasileira de Enfermagem. 2015;68(1):60-67
DOI 10.1590/0034-7167.2015680109i
Views0See moreObjective:
the aim of the study was to determine the prevalence of non-adherence to antihypertensive drug treatment and its association with factors bio-socio-economic and welfare.
Method:
it was a descriptive, cross-sectional study, performed with 422 hypertensive individuals. Data were collected through home interviews, conducted between December 2011 and March 2012.
Results:
the results showed that the respondents were mostly female, married, elderly, low income and little time of diagnosis. Were considered non adherent to medication 42.65% of participants. Non-Caucasian hypertensive patients, with fewer than eight years of schooling, who did not regularly attend doctor’s appointments, took more than two anti-hypertensive medications and did not have private health insurance, showed higher likelihood of not complying with the drug treatment.
Conclusion:
these findings suggest that hypertensive patients with unfavorable socioeconomic characteristics and difficulty of access to the service require different interventions in order to encourage them to adhere to medication treatment.
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Adherence and knowledge about the use of personal protective equipment among manicurists
Revista Brasileira de Enfermagem. 2015;68(1):52-59
Abstract
Adherence and knowledge about the use of personal protective equipment among manicurists
Revista Brasileira de Enfermagem. 2015;68(1):52-59
DOI 10.1590/0034-7167.2015680108i
Views0See moreObjective:
this study aimed to assess adherence and knowledge of manicures/pedicures on the use of Personal Protective Equipment (PPE).
Methods:
it was a survey with 235 manicures/pedicures in salons, Belo Horizonte/Brazil. Data were analyzed with the software Statistical package for the social sciences (17.0), using descriptive statistics, chi-square and logistic regression.
Results:
the adherence and the knowledge of the professional were evaluated using the median of the results, obtaining 52% and 63% respectively. The professionals younger than 31 were more likely (2.54 times) to adhere to PPE and those who claimed to have done biosafety course and to use uniform during work, had better chance of understanding (2.86 and 3.12 times, respectively). The majority (83.4 %) stated that the use of PPE should occur for all procedures, meanwhile 71.5 % cited not use them.
Conclusions:
the results indicate the poor adherence to PPE, strengthen occupational biological risk and need for training of these professionals.
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Predictive value of the Manchester Triage System: evaluation of patients’ clinical outcomes
Revista Brasileira de Enfermagem. 2015;68(1):45-51
Abstract
Predictive value of the Manchester Triage System: evaluation of patients’ clinical outcomes
Revista Brasileira de Enfermagem. 2015;68(1):45-51
DOI 10.1590/0034-7167.2015680107i
Views0See moreObjective:
to analyze the predictive value of the Manchester Triage System in relation to clinical outcome of patients.
Methods:
prospective observational study of 577 patients admitted to the ER and subjected to risk classification. The Therapeutic Intervention Scoring System-28 (TISS-28) was used to measure the severity of patients (primary outcome) and secondary outcomes: high / transfer, death, and length of hospital stay. Descriptive and univariate analyzes were conducted.
Results:
patients classified as red are 10.7 times more likely to have scores above 14 in TISS-28 in relation to others. Patients classified as red have 5.9 times more chance of progression to death compared to others. Patients of high priority service are 1.5 times more likely to be hospitalized over five days than low priority.
Conclusions:
STM proved a good predictor of clinical outcomes.
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Entrepreneurship in Nursing: overview of companies in the State of São Paulo
Revista Brasileira de Enfermagem. 2015;68(1):40-44
Abstract
Entrepreneurship in Nursing: overview of companies in the State of São Paulo
Revista Brasileira de Enfermagem. 2015;68(1):40-44
DOI 10.1590/0034-7167.2015680106i
Views0See moreObjective:
the present study aimed to identify and characterize nursing companies managed by entrepreneur nurses registered at the Commercial Registry of São Paulo by 2011.
Method:
it’s a descriptive, exploratory study, whose data collection, made throughout January 2012, was carried out on the Commercial Registry of Sao Paulo website. This non-governmental body has the function of registering the opening of companies and supervising their trade situation.
Results and conclusion:
this study allowed us to identify that the entrepreneur nurse is a growing reality through the identification of 196 companies opened by these professionals. Afterwards, it was analyzed their time of functioning, the main economic activity of the company, capital value, percentage of nurse partners and the distribution of companies by region of Sao Paulo State.
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Knowing blood donation surroundings: Implications for nurse service in hemotherapy
Revista Brasileira de Enfermagem. 2015;68(1):32-39
Abstract
Knowing blood donation surroundings: Implications for nurse service in hemotherapy
Revista Brasileira de Enfermagem. 2015;68(1):32-39
DOI 10.1590/0034-7167.2015680105i
Views0See moreObjective:
the study aims at discussing the significations apprehended by the non-blood donators, considering the context and the consequences of the acting of the nurse in hemotherapy.
Method:
it is a qualitative approach, with theoretical frame of Symbolic Interactionism and Grounded Theory method. The data production was carried out by intensive interview with subjects of three sample groups of a University Hospital of Rio de Janeiro City.
Results:
the phenomenon originated two analysis categories: “Perceiving the blood matter” and “Reflecting about the blood donation campaigns”. It was observed that the environment of the donor is not composed by contact with the other and the information that it can achieve, including the media.
Conclusion:
these were the main basis for the knowledge of blood donation according to their beliefs, culture and values. Therefore, all these aspects must be considered by the nurse acting on donors capture.
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ORIGINAL ARTICLE12-16-2024
Complexities of nursing in healthcare waste management in hospitals
Revista Brasileira de Enfermagem. 2024;77(6):e20230391
Abstract
ORIGINAL ARTICLEComplexities of nursing in healthcare waste management in hospitals
Revista Brasileira de Enfermagem. 2024;77(6):e20230391
DOI 10.1590/0034-7167-2023-0391
Views0See moreABSTRACT
Objectives:
to understand how healthcare waste management is developed by nursing professionals in hospitals.
Methods:
qualitative research, whose theoretical and methodological frameworks were Complexity Theory and Grounded Theory. Thirty-two nursing professionals from a public hospital in Rio de Janeiro participated in the study. Semi-structured interviews were used.
Results:
nursing affects healthcare waste management multidimensionally. Shortage of materials and work overload were identified as factors that influence professionals’ decision-making and increase the risk of improper waste disposal. The lack of knowledge on the subject also influences nursing practice. However, professionals value actions related to hazardous waste.
Final Considerations:
nursing professionals recognize themselves in healthcare waste management and understand the need to develop systemic awareness for sustainable practice.
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ORIGINAL ARTICLE12-16-2024
Predisposing factors for symptoms of anxiety, depression, and insomnia in university students
Revista Brasileira de Enfermagem. 2024;77(6):e20230387
Abstract
ORIGINAL ARTICLEPredisposing factors for symptoms of anxiety, depression, and insomnia in university students
Revista Brasileira de Enfermagem. 2024;77(6):e20230387
DOI 10.1590/0034-7167-2023-0387
Views0See moreABSTRACT
Objectives:
to characterize the sociodemographic and psychological aspects of university students who sought psychiatric care at a Student Support Center of a Federal University and to analyze associations between mental health issues and predisposing factors.
Methods:
a retrospective analysis of 103 medical records was conducted. The statistical analysis consisted of two steps: a descriptive analysis and a predictive analysis using the Logistic Regression Model.
Results:
the majority of the students were female. Symptoms of anxiety, depression, and insomnia were the main reasons for seeking care. Students who reported having emotional difficulties that negatively impacted their studies and those who had undergone some form of health treatment showed a higher probability of experiencing anxiety symptoms. Notable correlations were found between anxiety and emotional difficulties, depression and diarrhea, and insomnia and a sedentary lifestyle.
Conclusions:
symptoms of anxiety, depression, and insomnia led students to seek psychiatric care at the university. Understanding the predisposing factors for mental health issues in university students can inform care strategies and promote academic success.
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ORIGINAL ARTICLE12-16-2024
Educational technology to empower patients as participants in their care
Revista Brasileira de Enfermagem. 2024;77(6):e20230359
Abstract
ORIGINAL ARTICLEEducational technology to empower patients as participants in their care
Revista Brasileira de Enfermagem. 2024;77(6):e20230359
DOI 10.1590/0034-7167-2023-0359
Views0See moreABSTRACT
Objectives:
to build and validate an educational technology to empower patients as participants in their own care.
Methods:
methodological study to develop an educational technology based on the elaboration, validation, and evaluation that were carried out in five stages at a teaching hospital in Amazonas. The study was carried out from 2019 to 2022, with the participation of 19 judges specialized in patient safety and 72 patients admitted to the hospital’s medical and surgical clinics, the study setting.
Results:
the agreement between the judges obtained an overall index of 0.85, being considered validated. The overall analysis of the booklet obtained an assessment of the level of agreement above 85%.
Final Considerations:
the educational technology presented here was validated and suitable for promoting patient/professional rapprochement and consolidating health care in a way that increases the patient’s ability to contribute to their treatment and prevent the occurrence of adverse events.
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REVIEW12-16-2024
Strategies for expanding vaccination coverage in children in Brazil: systematic literature review
Revista Brasileira de Enfermagem. 2024;77(6):e20230343
Abstract
REVIEWStrategies for expanding vaccination coverage in children in Brazil: systematic literature review
Revista Brasileira de Enfermagem. 2024;77(6):e20230343
DOI 10.1590/0034-7167-2023-0343
Views0See moreABSTRACT
Objectives:
to identify the strategies found in the literature for increasing vaccination coverage among children in Brazil. It is justified mainly by the current scenario of falling vaccination coverage.
Methods:
systematic literature review. The search was carried out in the Pubmed (MEDLINE), Embase and Scopus databases, following the PRISMA guidelines.
Results:
initially, 4,824 results were returned. In the end, 6 studies were included for narrative synthesis using the SWiM methodology. Of these, 50% dealt with studies related to the Bolsa Família Program (PBF). The others explored strategies for approaching parents directly, Rapid Vaccination Monitoring (MRV) and the Community Health Agents Program (PACS). The PBF did not guarantee compliance with the conditionality of keeping vaccinations up to date. The MRV and PACS are effective strategies, especially because they allow active search for absentees.
Conclusions:
we conclude that more publications are needed on strategies to increase vaccination coverage among children in Brazil.
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ORIGINAL ARTICLE12-16-2024
The nursing practice environment and hospital sociotechnical complexity: a mixed-methods study
Revista Brasileira de Enfermagem. 2024;77(6):e20230315
Abstract
ORIGINAL ARTICLEThe nursing practice environment and hospital sociotechnical complexity: a mixed-methods study
Revista Brasileira de Enfermagem. 2024;77(6):e20230315
DOI 10.1590/0034-7167-2023-0315
Views1See moreABSTRACT
Objectives:
to analyze the relationship between the nursing practice environment and hospital sociotechnical complexity as perceived by nurses.
Methods:
a sequential explanatory mixed-methods study was conducted in a hospital in southern Brazil. The Brazilian version of the Practice Environment Scale-Nursing Work Index and the Complexity Characterization Questionnaire were administered to 132 nurses. Subsequently, semi-structured interviews were conducted with 18 participants, and the data were subjected to thematic analysis. Data integration was achieved through a connection approach.
Results:
the nursing practice environment was found to be favorable, except in the subscale concerning Staffing and Resource Adequacy, where complexity was present in the activities. The three emerging categories explained human and technical aspects related to complexity in the practice environment, quality of care, and patient safety. Unexpected variability was inversely correlated with the practice environment.
Conclusions:
the study results indicate a relationship between these constructs, with implications for the quality and the safety of care.
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ORIGINAL ARTICLE12-16-2024
Factors associated with maternal well-being during childbirth among postpartum women in Minas Gerais
Revista Brasileira de Enfermagem. 2024;77(6):e20230304
Abstract
ORIGINAL ARTICLEFactors associated with maternal well-being during childbirth among postpartum women in Minas Gerais
Revista Brasileira de Enfermagem. 2024;77(6):e20230304
DOI 10.1590/0034-7167-2023-0304
Views0See moreABSTRACT
Objectives:
to analyze the factors associated with maternal well-being during childbirth among postpartum women in Minas Gerais.
Methods:
a cross-sectional study nested within a cohort was conducted with postpartum women in a municipality of Minas Gerais. The Maternal Well-being in Childbirth Scale 2 was used. The prevalence of maternal well-being during childbirth was estimated. The magnitude of the association between maternal distress and care practices was estimated using the Prevalence Ratio (PR), applying Poisson regression.
Results:
a total of 183 postpartum women aged between 15 and 46 years participated, with 26.2%, 27.9%, and 45.9% reporting excellent, adequate, and poor well-being during childbirth care, respectively. Maternal distress was more prevalent among women who underwent cesarean sections (PR = 1.60) and those who did not receive breastfeeding information (PR = 1.59).
Conclusions:
a high prevalence of maternal distress during childbirth was observed, associated with cesarean delivery and the lack of breastfeeding information.
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ORIGINAL ARTICLE12-16-2024
Prevalence and factors associated with musculoskeletal pain among hospital cleaning staff
Revista Brasileira de Enfermagem. 2024;77(6):e20230237
Abstract
ORIGINAL ARTICLEPrevalence and factors associated with musculoskeletal pain among hospital cleaning staff
Revista Brasileira de Enfermagem. 2024;77(6):e20230237
DOI 10.1590/0034-7167-2023-0237
Views0RESUMO
Objetivos:
verificar a prevalência e os fatores associados à dor musculoesquelética em trabalhadores do serviço hospitalar de limpeza.
Métodos:
estudo transversal, realizado com trabalhadores de limpeza de um hospital de ensino do Sul do Brasil. Utilizaram-se questionário com variáveis sociodemográficas, laborais e de saúde, o Nordic Musculoskeletal Questionnaire e o Diagrama de Corlett e Manenica. Realizou-se análise bivariada.
Resultados:
participaram 149 trabalhadores. Prevaleceu dor musculoesquelética na coluna lombar no último ano (65,8%) e últimos sete dias (42,3%). Constataram-se associações entre automedicação e dor na parte inferior das costas (p=0,020) e ombros (p=0,026); sedentarismo, oito horas de sono diárias e dor nos tornozelos (p=0,041) e pés (p=0,039); ex-tabagismo, uso de medicamento e dor nos punhos (p=0,015) e mãos (p=0,004).
Conclusões:
prevaleceram lombalgias associadas a hábitos de saúde e vida. Um programa de educação em saúde e recomendações de melhorias nos processos de trabalho podem minimizar a exposição à dor musculoesquelética.
Keywords:Dor MusculoesqueléticaSaúde do TrabalhadorServiço Hospitalar de LimpezaServiços HospitalaresTranstornos Traumáticos CumulativosSee more
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